Azathioprine
is one of a series of drugs called "immunosuppressives". This means
that they alter the way in which the immune system is working in various forms
of arthritis. It is not a painkiller.

WHAT DOES
AZATHIOPRINE DO ?

Azathioprine alters the
way in which diseases such as rheumatoid arthritis affect the joints by altering
the function of the immune system. Azathioprine can decrease the numbers and
activity of the cells lining the joint which are responsible for attracting
white blood cells from the circulation into the effected joint. This means that
there will be fewer white blood cells present inside the joint which produce the
chemicals that cause pain, joint swelling and damage to the cartilage and bone
inside the joints.

HOW DO I TAKE
AZATHIOPRINE ?

Azathioprine is available
in tablets of either 25 or 50 mg. These should be taken with a meal to reduce
stomach upsets. It may be prescribed as a single dose or to be taken twice a
day. Usually the starting dose will be between 50 to 100mg per day. The
maintenance dose for most people is between 100-200mg per day depending on how
well the disease is controlled.

WILL MY ARTHRITIS GET
BETTER ?

Most patients starting
azathioprine respond quite well, with many patients improving quite
dramatically. Some patients may even go into a "remission", where the
arthritis virtually disappears. A minority of people do not respond well to
azathioprine and in this case, it is sometimes helpful to continue on a little
longer with a higher daily dose.

HOW LONG WILL IT TAKE TO
WORK

Usually it takes between
8 to 12 weeks before you will notice any improvement in your arthritis. This
doesn't mean that azathioprine won't work so do not get discouraged !!. Often
you will be given other medications when you start azathioprine so that you will
improve more quickly. If it is effective, treatment may be continued for months
or even years.

ARE THERE ANY SIDE
EFFECTS ?

As with all medications,
there is a potential for side effects to occur. The most common side effect is
nausea which is less frequent if azathioprine is taken with food. Itchy rashes,
a sore mouth or throat and mouth ulcers may occur. Sometimes the liver may be
irritated by azathioprine which causes abnormal blood tests, but this very
rarely causes any symptoms.

There are some
potentially serious side effects with azathioprine, mainly concerning the blood
count. Azathioprine can cause a drop in the numbers of white blood cells which
are needed to fight infection. Because your doctor monitors your blood count
very closely, it is unusual for this to be a serious problem. Also, azathioprine
can decrease the numbers of cells called platelets in the blood, but again it is
rare for this to actually cause problems. If however you develop mouth ulcers,
easy bruising, nosebleeds or bleeding gums, your doctor needs to know about this
straight away.

Because the immune system
may be depressed, you should avoid contact with people with infectious diseases
such as chicken pox and consult with your doctor before having any vaccinations.

As the skin may become
more sensitive to the sun's harmful rays you should avoid excessive exposure.
Wear a hat and sunscreen when outside in the sun.

HOW OFTEN DO I
NEED TO HAVE MY BLOOD COUNTS TESTED ?

Azathioprine may effect
the blood count and the liver, so blood tests will be necessary every 2 weeks
for the first 8 weeks of treatment and monthly after this. This makes giving
azathioprine as safe as possible.

DO ANY OTHER MEDICATIONS
INTERFERE WITH AZATHIOPRINE

Generally there are
no drugs that make a side effect more likely or which interact with azathioprine,
particularly most anti-inflammatory tablets or painkillers. However, certain
medications (allopurinol) which are used in the treatment of gout may elevate
the level of azathioprine in the blood and these are best avoided or the dose
modified.

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This page was last updated on January 17, 2001